Workers' Compensation is a state-mandated benefit for employees with work-related injuries and illnesses, awarded without regard to who is at fault. Employers are required to provide benefits in case of injury, illness, death, or aggravation of a pre-existing condition resulting from employment. For the University of California, these benefits are administered by a self-insured plan. There is no outside insurance carrier. The University contracts with a third-party administrator, Sedgwick CMS, for the management of its claims. Employees should follow the steps below to properly report their injury and obtain treatment.
Direct employees to report all work-related injury to employee’s manager or supervisor.
Direct your employee to seek Medical Attention: UCLA Health’s Workers’ Compensation Third Party Administrator directs the employee’s medical treatment for an initial 30 days after an employee has reported a work-related injury.
Employees should obtain medical treatment at UCLA Occupational Health Facility (OHF) or designated UCLA Occupational Health Clinic Partner for non-emergencies that occur during normal business hours, or the RRMC/SMUCLA Emergency Department for emergencies and/or off-hours treatment. After the Emergency Department initial visit, employees should be seen at OHF or designated UCLA Occupational Health Clinic Partner for any follow-up treatment required. OHF or designated UCLA Occupational Health Clinic Partner will evaluate and direct any referrals for therapy, diagnostics or specialist appointments as indicated.
***Instruct the employee to identify themselves to the ED staff as a UCLA Employee with a work-related injury***
Occupational Health Facility (OHF)
Location: First floor main lobby of CHS, near Café Med
Address: 10833 Le Conte Avenue, Suite 17-240 CHS
Phone: 310-825-6771
Click here for hours and directions to OHF office
Ronald Reagan UCLA Medical Center (RRUCLAMC)
Location: 757 Westwood Plaza (Emergency Room entrance on Gayley Avenue)
Phone: 310-267-8400
Emergency Room Hours: 24 hours a day, 7 days a week
Santa Monica UCLA Medical Center (SMUCLA)
Location: 1255 15th Street, Santa Monica 90404
Phone: 424-259-8400
Emergency Room Hours: 24 hours a day, 7 days a week
Off-Campus Employees = More Than 30-Minutes Travel Time From UCLA Campus
If the injured employee works at an off-campus location that would take more than 30 minutes to get to the UCLA Occupational Health Facility, then the employee may be seen at our Occupational Health Clinic Partners Concentra or Kaiser on the Job.
Click here to find a Concentra Clinic that is closest to you
Employees who will be seen at Concentra must be provided with this Authorization form to take with them to the clinic.
For Kaiser on the Job, please contact the HR Workers’ Compensation unit at 310-794-3036 for assistance.
SERIOUS INJURIES: Page the Office of Environmental Health & Safety (EH&S) IMMEDIATELY (Pager: 90248)
Serious injury includes:
*If serious injuries are not reported within 8 hours, departments can be fined $5,000.00 by Cal/OSHA.
Provide the employee with the Workers’ Compensation Paperwork:
Employees may complete the paperwork prior to OHF visit if time permits or may complete after initial visit as soon as possible.
Workers' Compensation Claim Form (DWC 1) & Notice of Potential Eligibility
Manager fills out lines 1, 12-14 and 17-19. Employee completes line 2-8 and signs. submit the completed claim form to the Workers’ Compensation Team via email to: [email protected] or by fax: 310-794-3337
Workers’ Compensation Incident Report and Referral for Medical Treatment
Manager completes this form with the employee describing how the injury occurred, when, where. Note the date the injury was reported.
USE THIS FORM TO DOCUMENT FIRST AID INCIDENTS.
Please submit the completed claim form and other paperwork to the Workers’ Compensation Team via email to: [email protected]
or by fax: 310-794-3337
My employee has just been seen at UCLA Occupational Health for an injury, what happens next? Click here for important information
